Thursday, December 01, 2005

"Pharmacists for Life": Lying wingnuts for God.

(While this posting relates to "pro-life" pharmacists in the United States, I'll shortly be looking into this whole situation (again) here in Canada, so just consider this an appetizer for how fucked up things can get this side of the border.)

A recent article discussing the suspension of four pharmacists in Illionis who refused to fill birth-control prescriptions has a little good news but, relatively speaking, far more bad news for folks who like the ability to walk into a pharmacy and get their prescription filled without getting a sanctimonious lecture from Christian moralists.

In this article from the Boston Globe, we find that the Walgreen chain clarifies a couple issues while muddying far more. Let's consider the good news first, as Walgreen acknowledges that state law in Illinois trumps corporate policy or pharmacists' rights (all emphasis added):

Walgreen Co. said it has put four Illinois pharmacists in the St. Louis area on unpaid leave for refusing to fill prescriptions for emergency contraception in violation of a state rule...

The licenses of both a pharmacy and that store's chief pharmacist could be revoked if they don't comply with the Illinois rule, [Walgreen spokeswoman Tiffani] Bruce said.

Walgreen, based in Deerfield, Ill., put the four on leave Monday, Bruce said. She would not identify them. They will remain on unpaid leave ''until they either decide to abide by Illinois law or relocate to another state" without such a rule or law.

Walgreen policy says pharmacists can refuse to fill prescriptions to which they are morally opposed -- except where state law prohibits -- but they must take steps to have the prescription filled by another pharmacist or store, Bruce said.

Now, the above is certainly good news since it makes it clear that state law will absolutely take precedence over religious objections but, unfortunately, from there it's all downhill. In the case where there is no such state law, what's going to happen?

First, re-read that final paragraph (emphasis added):

Walgreen policy says pharmacists can refuse to fill prescriptions to which they are morally opposed -- except where state law prohibits -- but they must take steps to have the prescription filled by another pharmacist or store, Bruce said.

And what exactly does that policy actually mean? Frankly, not much as it's semantically meaningless.

How would you interpret "they must take steps to have the prescription filled by another pharmacist or store"? Well, if you accept that you can have the prescription filled by another store, why would you bother even mentioning it might be filled by another pharmacist? If this were, hypothetically, the choice enforced on a pharmacy, they could always refuse to fill the prescription since they always have the second choice of sending it to another store, so that policy is, quite simply, meaningless. But it gets worse.

Note that Walgreen's policy suggests that the wingnut pharmacist (and I want you to read the next few words carefully) "must take steps to have the prescription filled ...". Note the significant word "must". This suggests that the pharmacist can't just say, "No, not here but, hey, there's another pharmacy across town, you might want to try there, who knows?"

No, that word suggests that the pharmacist has an obligation to make sure the prescription is filled and I'm not sure if that's what Walgreen had in mind. Is that really what they're promising? That the pharmacist is guaranteed to make sure that prescription gets filled? I'm not at all convinced that's what they really meant.

And even if it is what they meant, what might that involve? Perhaps calling up another pharmacy 20 miles away, making sure they can fill it, then sending the annoyed customer on their less-than-merry way? That doesn't strike me as a satisfactory arrangement so I'd want to know precisely what Walgreen is trying to say here. But here's the best part.

Walgreen is clearly suggesting that, if there is no state law to enforce good behaviour on their part, then their pharmacists will still make some (currently badly-defined) effort to help the customer. This would come as a surprise to "Pharmacists for Life" president Karen Brauer who, earlier this year, made it absolutely clear that such pharmacists were under no obligation whatever to help in any way:

On CNN, Brauer said that, though she refused to fill a prescription for birth control pills, she "offered to transfer her prescription to the pharmacy of her choice, because the prescription is her property in the state of Ohio."

But Brauer and Pharmacists for Life have both publicly denounced such transfers. The Washington Post reported on March 27:

Brauer, of Pharmacists for Life, defends the right of pharmacists not only to decline to fill prescriptions themselves but also to refuse to refer customers elsewhere or transfer prescriptions.

"That's like saying, 'I don't kill people myself but let me tell you about the guy down the street who does.' What's that saying? 'I will not off your husband, but I know a buddy who will?' It's the same thing," said Brauer, who now works at a hospital pharmacy.

Likewise, the Associated Press reported on September 16, 2004, that Brauer "does not believe there should be any obligation to refer rebuffed customers to another pharmacist who would fill their prescription. 'Forced referral is stupid,' she said. 'If we're not going to kill a human being, we're not going to help the customer go do it somewhere else.' "

Brauer further explained her opposition to referrals in Drug Topics:

"There is no moral or ethical obligation to tell a person where to get a drug that is detrimental," Brauer said. "Any patients who can transport themselves to a pharmacy can obtain the product they desire without need of a direct referral. Patients have proven themselves to be quite resourceful in obtaining pharmaceuticals. The referral rhetoric has been a tool to obtain involvement by the unwilling in dispensing drugs that stop human life or are detrimental. Obtaining the involvement of the unwilling has been used as a tool to legitimize the procedures and drugs that are in controversy."

Brauer's organization, Pharmacists for Life, goes even further, explicitly denouncing pharmacists who -- as Brauer claims to have done -- refer patients to other pharmacists who will fill the prescription:

A pharmacist by virtue of properly understood conscience cannot be licitly compelled to cooperate in such a fashion with what he knows will result in a chemical abortion and, hence, a dead baby. Such activity is called material cooperation. Further, it is not an inconvenience to refuse to refer such a client since the pharmacist is doing the woman and her preborn child a favor in terms of physical and spiritual health.

Material cooperation with such an evil can never be licit even if it may be lawful, as it is in today's society. In fact, pharmacists aware of the evil nature of such a scenario would have a duty as a pharmacist and a person not to cooperate in such an evil even under pain of serious adverse ramifications. Some authors, hiding their publicly stated support for any and all baby killing, have erroneously stated shameful opinions which equivocate on the rights of conscience and thus claim a pharmacist may have a right of conscience, but if all else fails, he must cooperate with the evil in our example. Such thinking shows the irrational absurdity and confusion in the minds of those who adhere to such ideas.

In short, Pharmacists for Life have made it clear that they are adamantly opposed to the very policy Walgreen is now advertising. One can be forgiven for suggesting that it would be entertaining to get these two parties in the same room and not let them out until they figure out who's at the top of this particular food chain.

ADDENDUM: If you return to the MediaMatters article, you can see where the American Pharmacists Association has a policy that is equally vacuous and content-free:

According to The Washington Post, "The American Pharmacists Association [APA] recently reaffirmed its policy that pharmacists can refuse to fill prescriptions as long as they make sure customers can get their medications some other way." APA vice president for policy and communications Susan Winckler explained:

What we suggest is that they identify those situations ahead of time and have an alternative system set up so the patient has access to their therapy. ... The key is that it should be seamless and avoids a conflict between the pharmacist's right to step away and the patient's right to obtain their medication.

This is not going to happen because, quite simply, there is no solution that will leave both parties satisfied. It is not physically possible so, regardless of what the APA claims, somebody is going to end up being pissed off.

You can find the Pharmacists for Life web site here, while the Canadian version is here, just so you Canadians can get a head start on being very afraid.

FOR YOUR HOMEWORK READING ASSIGNMENT: There was a flurry of posts on this topic some months back. Justin over at FPC mentions them, so you can start there and just follow the links back here to around April.

It just means I'm probably repeating myself to some extent, but it's probably worth seeing if anything's changed lately.

3 comments:

CanObserver
said...

Bizarre, truly bizarre. What a truly unfortunate situation. Will be checking back for the Canadian situation. Hope that we don't have the same self righteous, facist mind set, but suspect that it's happening here too.

If the Pharmicists want to take it to court in Illinois that would be a good thing I think. Since they would be found in violation of state law they effectively would not be allowed to work as Pharmicists in the state. this position would also be consistent with the APA stated professional standard.

In onther states with no such prohibition in the law there is little or no recourse for women than to go to Planned Parenthood, which will always provide responsible health care for women but may be a bit of a drive in some areas.